Organization
BRIDGE BACK TO LIFE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BUTCHEN (PRESIDENT)
(212) 679-4960
Entity
Organization
Contact information
Practice address
2857 W 8TH ST, BROOKLYN, NY 11224-3604
(718) 265-4200
(718) 265-8536
Mailing address
2857 W 8TH ST, BROOKLYN, NY 11224-3604
(718) 265-4200
(718) 265-8536
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
111111254
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075282
LMSW
NY
Enumeration date
11/25/2009
Last updated
11/25/2009
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